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Request for Academic Assistance

How to Use the Request for Assistance Form:

Complete the form below
Click on SUBMIT
Follow the prompt by choosing OK
Click YES at the next prompt. (Wait for the YES option to appear)

You will be contacted shortly once we receive your form.

Instructor Information ( Check is submitted by instructor)

:Instructor Name

:Email Address

:Course Title

:Course Number

Student Information (Check if submitted by student)

:Name

:G Number

:Phone Number

:Email Address

Comment Codes: (Check all that apply to students reading skills

Low quiz/test scores

Low grades on papers

Homework/assignments inconsistently done

Slow Reading Rate

Poor Reading Comprehension

Tutoring assistance recommended
Study skills assistance recommended
Test preparation and test-taking strategy development recommended

:Additional Comments

For more information Contact:

Elizabeth Gonzales, Learning Resources Coordinator

gonzalese@nfcc.edu

(850)973-9411

Location: Learning Resources Center (Building 6-Room 221)

Webmaster

325 NW Turner Davis Dr. Madison, FL 32340 850.973.2288 or 866.937.6322